At a special Gila Regional Medical Center Board of Trustees meeting Tuesday, May 21, Interim Board Chairman Charles Kelly said the reason for the meeting was to decide if there needed to be changes, and "if so, to what degree and what will happen in the interim."

"We all care for, love and need this hospital," Kelly continued. "I hope that whatever happens that we can come together. The hospital is one of the main features of Grant County. Let's care for it."

Board of Trustee member Robert "Bobby" Morales, Sr. said: "As a board, we are part of the Gila Regional family. We take to heart our mission. We are family and will stand together. There might be changes, and there might not. I appreciate everyone's cooperation. We are all here for the betterment of the hospital, the patients and the caregivers."

Kelly then opened up the meeting to public input.

Wayne Heath of the behavioral health team said he wanted to convey to the board that "I have had extreme support from the senior leaders and have full confidence in and appreciate the leadership."

James Vigil from the Western New Mexico University faculty said he was there to take notes on behalf of the faculty.

John Curran, cardio-pulmonary director, asked the board to keep the senior leadership in place. "I see them making headway, and I see the possibility of new services and revenues."

Dr. Nathan Williams, anesthesiologist, said a lot of his perspective came from being in Doña Ana County and seeing the challenges there. "Nothing is ever perfect. I've been very happy with this administration, especially comparing them with other administrations that were less ethical. We have a hospitalist who is coming from Colorado. He's leaving his hospital because he couldn't work with the new administration."

Rick Vasquez, a buyer at GRMC, said he is one of those being cut and going from 40 hours to 20 hours.

Lillian Galindo of the HealthReach department said she realized that hard decisions needed to be made. "My concern is they didn't communicate well. Twenty hours a week is not enough to live on. I've been here 19 years. I wish there had been more transparency and communication. I'm here to see what changes."

Laura Howell, web manager from the marketing department, said she had seen leadership come and go. "I understand best practices and this isn't. My concern is how we will navigate the hurdles we have ahead of us. What will it mean if this hospital becomes like the Deming hospital, where anyone who comes into the ER is shipped out? I'm one of the 70, if I were marketing it, I would do an image of half a person."

Virginia Holguin, who identified herself as a community member. "We depend on GRMC for our needs. My concern is that we want the hospital to be there for us people, and who work here. They are so personable, and I am wanting things not to change. It will impact some workers. Those on half pay, it's like when the mines shut down, people have to adjust."

Gayla Weise of the operating room said: "Our senior staff has done the best they could with the situation. They maybe didn't handle it with the best communication. I know this hospital cares about patients. I got cancer and have had excellent care. I don't think it's bad management. It's a hard situation, and I know senior administration cares. I have seen it firsthand that the hospital is a team. With the support of staff maybe more ideas will come out. I am willing to take a one-day a week cut, or cut me down to 35 hours a week."

Denise Baird, MediSurg director, read a letter to board members, which was signed by about 20 caregivers. Some of the thoughts from the letter are: "Your response will impact us. We totally support the senior administration. The decisions you made will always impact the hospital.  We think the decisions were made with good intentions. The senior administration actively supports patient safety and care."  

She said she has been at the hospital and has seen different administrations. "This is my family, and this is the best team I've seen."

Mary Harcinske, director of quality, said she has been in health care more than 30 years. "I feel the changes coming will be perhaps more disruptive than DRGs (diagnosis-related groups) that came in the early 1980s. I think the senior leaders have been proactive. The cuts and layoffs will be occurring. This is an excellent hospital, especially for a rural community. We need the continuing support of staff."

Janice Varela, Health Information Management director, said she codes patient encounters. "Health care is the most regulated business in America. Hospital charges do not equal reimbursements. For instance for the birth of a newborn, it costs $2000 to $3000. The reimbursement is $800. It costs $18,000 to $24,000 for a Caesarean section, but reimbursement is $4,000 to $4,500. Medicare and Medicaid reimburse 30 cents to 40 cents on the dollar. How can the hospital stay in business? Programs such as the Rural Hospital Initiative and the Sole Community Provider have helped keep rural hospitals alive. This situation we're in is the perfect storm, with cuts in programs and a reduction of 2 percent of Medicare because of the sequester. We must reduce expenses. The DRGs (a payment system Medicare uses) were a huge change. Now we have the ICD10 coding changes, with every department having to be in compliance by October 2014. These senior administrators have been on top of these issues. The coding change is why they hired me back. The senior administration team has worked to keep the directors informed."

Marie Stailey, financial director, said she is in charge of billing and accounts receivable. "We have real time information in the business office. 2013 is a pivotal year as we are preparing for the Affordable Care Act to go into effect Jan. 1, 2014. New Mexico has announced its Centennial Care, with four companies offering plans, but the details have not been rolled out. Medicaid rates are low. I don't know if they will change, but more people will be on Medicaid, as the government requires everyone to be insured. Open enrollment begins in October 2013. Insurers are already proposing rates like Medicare and Medicaid. That is unsustainable. With the sequestration, we are seeing a 2 percent cut in Medicare reimbursement. That is a $700,000 annual cut.  Whether by design or not, ways to pay hospitals are becoming more burdensome. Insurance companies are doing everything not to pay. Medicare is capping things that were being paid. I do know our efforts need to be supported by the experienced senior administrators."

Tami Bates in educational outreach said it is clear from the numbers and figures that the hospital is in tough times. "A common theme is that we are a big family. The lack of communication about what's coming is a concern. It's a very different and important job. Thank you for your service and I hope you do what is best for the hospital and community."

Chris DeBolt, director of education, said she has respect for all those in the room, including the board of trustees. "We have to stand for something. Try to remember when you are making critical decisions. We knew huge changes were needed. I think the directors should have had more input. We would have gotten to the same place you got with the half time cuts. You should have given us a chance to cut 10 percent here and 15 percent there. I think the opportunity was missed for consensus. What is concerning is those of us who are cut to half time. It's hard for them to pay for full-time insurance. Maybe it was an unintended consequence, but it is not economically feasible and not thought through. They will be unemployed and will come through the back door to get treatment. I think the issue should be thought about. Those who want to stay, perhaps pay for them through the end of the year. If we want to retain the best of what we have, we have to help them. If we are a Planetree hospital, we need to remember why. As for operational changes, I think more than one proposal is for everyone from my level up to take a 20 percent cut. I really respect the hard decisions you have to make."

The rest of the meeting will be in a subsequent article.